Type 1 Brugada Pattern Associated with Nicotine Toxicity

BackgroundBrugada pattern (BrP) findings on electrocardiogram (ECG) are mandatory for the diagnosis of Brugada syndrome (BrS). BrS is an incompletely understood cause of sudden cardiac death.Case ReportOur patient was a young woman who was using topical nicotine for assistance in smoking cessation at a relatively high dose compared to her daily cigarette intake. She presented with symptoms of mild nicotine toxicity and had an ECG with a type 1 BrP. An ECG the next day was normal and electrophysiology consultation was conducted.Why Should an Emergency Physician Be Aware of This?Recognition of a BrP ECG by emergency physicians is critical because this is the first step in diagnosing BrS, a condition that is characterized by ventricular dysrhythmias and sudden cardiac death. In addition, ECG abnormalities can be transient in nature, requiring vigilance by the emergency physician to prevent the patients' potential life threat from going undiagnosed. We present the first case to our knowledge of a BrP associated with nicotine toxicity. We also discuss treatment and disposition recommendations.